Gadolinium-based contrast agents (GBCAs) classified by risk of nephrogenic systemic fibrosis

Chemical name	Trade name in the United States	Vendor	Ligand class	Net charge	Tissue distribution	Biliary excretion
Group I: Associated with highest number of cases of nephrogenic systemic fibrosis
Gadodiamide	Omniscan	GE Healthcare	Linear	Nonionic	Extracellular	None
Gadopentetate dimeglumine	Magnevist	Bayer HealthCare Pharmaceuticals	Linear	Ionic	Extracellular	None
Gadoversetamide	OptiMARK	Covidien	Linear	Nonionic	Extracellular	None
Group II: Associated with few or no unconfounded cases^* of nephrogenic systemic fibrosis
Gadobenate dimeglumine	MultiHance	Bracco Diagnostics	Linear	Ionic	Extracellular	3%
Gadobutrol	Gadavist^¶	Bayer HealthCare Pharmaceuticals	Macrocyclic	Nonionic	Extracellular	None
Gadoterate meglumine	Dotarem	Guerbet	Macrocyclic	Ionic	Extracellular	None
Gadoteridol	Prohance	Bracco Diagnostics	Macrocyclic	Nonionic	Extracellular	None
Group III: Limited number of administrations with no cases of nephrogenic systemic fibrosis
Gadofosveset trisodium^Δ	Ablavar	Lantheus Medical Imaging	Linear	Ionic	Blood pool	None
Gadoxetate disodium	Eovist	Bayer HealthCare Pharmaceuticals	Linear	Ionic	Hepatocellular	50%

This classification scheme is based on that defined by the American College of Radiology. Other agencies have published similar but slightly different classifications.^[1,2]

* Unconfounded cases are those in which the implicated gadolinium agent was the only type that the patient received.

¶ Gadavist is also known as Gadovist in Europe.

Δ Gadofosveset trisodium, a group III GBCA, is no longer available for clinical use.

Adapted from: American College of Radiology. ACR manual on contrast media, version 10.3, 2018. Available at: https://www.acr.org/-/media/ACR/Files/Clinical-Resources/Contrast_Media.pdf (Accessed on April 10, 2018).

Additional references:

European Medicines Agency. Assessment report for gadolinium-containing contrast agents, Procedure no. EMEA/H/A-31/1097, 2010. Available at: https://www.ema.europa.eu/en/documents/referral/gadolinium-h-31-1097-assessment-report_en.pdf (Accessed on April 11, 2018).
Food and Drug Administration. Gadolinium-based contrast agents & nephrogenic systemic fibrosis: FDA briefing document. Joint meeting of the Cardiovascular and Renal Drugs and Drug Safety and Risk Management Advisory Committee, 2009.

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Gadolinium-based contrast agents (GBCAs) classified by risk of nephrogenic systemic fibrosis